On my long run this week, I listened to a podcast featuring Dr. Peter Attia promoting his new book Outlive: The Science & Art of Longevity.

Dr. Attia talks at length about the emergence of Medicine 3.0. The first wave, Medicine 1.0, was characteristic of ancient times when humors – blood, yellow bile, black bile, phlegm - and fickle gods determined our fates. Things shifted during Medicine 2.0 with the introduction of the scientific method bringing about hypothesis and testing that has led to clinical trials and the emergence of pharmaceuticals to treat diseases. Medicine 2.0, the period we are currently in, has successfully doubled the average adult life span from 40 to 80 years of age by reducing the devastating effects of diseases (smallpox, polio, hepatitis, etc.). However, Dr. Attia argues if you dig deeper into the data, Medicine 2.0 has little to reduce the mortality rate from endemic human causes of death.

For adults over 40, the top causes of death are heart disease, cancer, metabolic disease (e.g., diabetes, high blood pressure), and accidental death, such as from car crashes and falls. Medicine 2.0 has done little to address these underlying causes of death for adults. Dr. Attia states that the mortality rate from these causes is nearly the same as one hundred years ago. Enter Medicine 3.0.

The goal of Medicine 3.0 is to extend human longevity by actively including nutrition and exercise alongside modern medicine. The next wave of medicine must focus on prevention, not just treatment to address heart disease, cancer, and metabolic conditions. Today's cadre of doctors was not trained as healthcare preventers. Dr. Attia recounts learning much about pharmaceuticals and biochemistry in medical school but not about nutrition and exercise. A shift to prevention would change the focus of doctors.

Dr. Attia states two variables correlate highest with longevity: VO₂ max and strength. VO₂ max is an established indicator of cardiovascular fitness. The metric shows how well your heart and veins push blood to your muscles and the rest of your body. Strength measures how well you can push, pull and lift. Strength does not mean massive muscle mass – it is your ability to manipulate body weight through various exercises such as pullups, pushups, and situps. Numerous clinical studies have shown the relationships between lower mortality rates from cancer, heart disease, and death from VO₂ max and muscle strengthening activities.

Now imagine the annual visit to your physician in the era of Medicine 3.0. Your height, weight, and blood pressure are checked as usual. But then, you head to a treadmill connected to a breathing mask and heart rate sensors. Ten minutes later, exhausted and heavily perspiring, your physician has the annual read on your Vo2 max. You sip water and then drop to the floor for a timed two-minute test of situps, pushups, and pull-ups. Is anyone having flashbacks to elementary school gym class? Your doctor furrows her eyebrows, scribbles illegibly, and pecks at a computer keyboard. You see a graphical display of how your health ranks with your peers. From there, your doctor prescribes a course of action that includes visiting your local pharmacy and a weekly exercise program.

As runners, we are proactively extending our longevity, but there is an opportunity to improve. VO₂ max improvement is a natural component of run training. Strength is where many runners, including myself, are lacking. Message boards are filled with reasons why strength sessions, situps, and pullups hinder running due to upper body muscle mass imbalance, excess weight, etc. This is all probably true. But what is our objective in running? If the goal is to become healthier versions of ourselves, then the evidence is clear that strength training should be part of our weekly routine.

So, how many push-ups can you do?